MALT lymphoma arising on a background of reactive pulmonary lymphoid hyperplasia in a patient with Systemic Lupus Erythematosus

Abstract

Interstitial lung diseases are not infrequently complicated by development of malignancies and whilst most cases are carcinomas, rare cases of lymphoma have been reported,^{1 2} these being diffuse large B-cell lymphomas and often associated with connective tissue disorders (CTDs). Reactive pulmonary lymphoid hyperplasia (RPLH), typically in the form of lymphoid interstitial pneumonia (LIP) often arises in patients with CTDs and only rarely shows malignant transformation,³ with many of the early putative cases of transformation to MALT (mucosa-associated lymphoid tissue) lymphoma from LIP being lymphoma 'de novo'.⁴ Herein we present a case of pulmonary non-Hodgkin lymphoma of MALT origin arising on a background RPLH with coexistent amyloidosis, confirmed by immunohistochemical and clonality studies. A 57 year old Caucasian female presented with chest pain and breathlessness at rest. She also described intermittent cough with small amounts of sputum, intermittent sweats, fatigue and joint pain in hands, feet, wrists, knees. She was known to have systemic lupus erythematosus (SLE) and SLE-related antiphospholipid syndrome for which she received immunosuppressive therapy including mycophenolate, prednisolone and hydroxychloroquin.

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